Comparative Effectiveness and Safety of Disease-modifying Treatments (DMTs) in a Real-World Neuromyelitis Optica Spectrum Disorder Cohort (NMOSD)

electrographic seizures.Empiric high dose IV steroids were initiated.The patient was found to have a very elevated antithyroid peroxidase antibody levels with normal thyroid function studies.The remainder of her extensive laboratory work-up was negative.Her mentation dramatically improved with a course of IV steroids, thus confirming our suspicion for SREAT.She was ultimately discharged on a six-week oral steroid taper, however re-presented three months later with severe headaches.Repeat imaging demonstrated a new area of right temporal hyperintensity.Her symptoms improved after re-initiation of pulse dose steroids and she was thus discharged with an extensively prolonged steroid taper.The patient continues to do well and has returned to work as a registered nurse. ConclusionsSREAT is an underrecognized cause of RPE that can present with new onset seizures and non-vascular MRI lesions.This case illustrates that clinicians should include anti-thyroid antibodies in their workup for encephalopathy.Treatment should be considered in noninfectious patients, as the dramatic improvement in mentation is pathognomonic.